Authors: Zachary Sanford; Justin Turcotte, MBA; Haley Taylor; Andrew Broda, BS; Alex Speciale, MD; Chad Patton, MD, MS (Annapolis, MD)
Adequate postoperative pain-control in patients undergoing spinal surgery remains a difficult subject of study. Although opioid medications have traditionally been utilized in managing spinal pain, little is known regarding their short and long-term postoperative utilization.
Retrospective analysis was conducted on a consecutive series of spine surgery patients from May 2014–April 2016 managed by two surgeons at a single high-volume orthopaedic center. Opioid prescription fill data through twenty-four months post-procedure was obtained via Surescripts© (Arlington, VA) with patients subdivided into opioid-naïve [ON] (no opioid prescription fills) or opioid non-naïve [ONN] (≥1 opioid prescription fills) within four months prior to surgery. Thirty day preoperative periods were excluded from analysis to control for prescriptions written to bridge therapy prior to surgery as were patients undergoing multiple procedures. Opioid concentrations were converted into morphine milligram equivalents (MME).
287 patients (194 ON, 93 ONN) were included in this study. Postoperatively, ONN patients’ prescription fills decreased from 34% in months 0-3 (MMEx̄ 3,078) to 14% by 9-12 months (MMEx̄ 5,715) with no fills in months 21-24. Pain management accounted for the majority of opioids prescribed during the 12-month postoperative period (64%). Conversely, ON patients’ percentage of prescription fills increased from 21% in months 0-3 (MMEx̄ 1,410) to 22% in months 9-12 (MMEx̄ 2,541), remaining at 29% by months 21-24. Pain management prescribed the majority of total opioids during the 12-months following surgery followed by other specialties and primary care (37%, 27%, 21%).
Our findings suggest spine surgery patients are at risk for ongoing opioid medication use long after surgery, the majority of which are prescribed by non-surgeon providers. Although spine surgery appears to be an effective intervention for reducing opioid dependence among ONN individuals, opportunities exist to reduce postoperative opioid utilization among ON patients through implementation of revised pain management protocols.